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Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score.

Lucas MJ, Brouwer MC, van der Ende A, van de Beek D - Neurol Neuroimmunol Neuroinflamm (2014)

Bottom Line: Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%).However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale.However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.

ABSTRACT

Objective: In bacterial meningitis, a decreased level of consciousness is predictive for unfavorable outcome, but the clinical features and outcome in patients presenting with a minimal score on the Glasgow Coma Scale are unknown.

Methods: We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the Glasgow Coma Scale from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012.

Results: Thirty of 1,083 patients (3%) presented with a score of 3 on the Glasgow Coma Scale. In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained by use of sedative medication or complications resulting from meningitis such as seizures, cerebral edema, and hydrocephalus. Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%). However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale. Patients presenting with a minimal Glasgow Coma Scale score on admission and bilaterally absent pupillary light responses, bilaterally absent corneal reflexes, or signs of septic shock on admission all died.

Conclusions: Patients with community-acquired bacterial meningitis rarely present with a minimal score on the Glasgow Coma Scale, but this condition is associated with high rates of morbidity and mortality. However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

No MeSH data available.


Related in: MedlinePlus

Distribution of scores on Glasgow Coma Scale for adults presenting with community-acquired bacterial meningitis
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Figure 1: Distribution of scores on Glasgow Coma Scale for adults presenting with community-acquired bacterial meningitis

Mentions: From 2006 to 2012, 1,083 episodes of community-acquired bacterial meningitis were included in the cohort. Thirty of 1,083 patients (3%) presented with a Glasgow Coma Scale score of 3 on admission (figure 1). Fifteen patients (50%) were female and the median age was 65 years (interquartile range 49–76 years; table 1). Fifteen patients (50%) had one or more predisposing conditions for bacterial meningitis, consisting of otitis/sinusitis in 8, immunocompromised state in 6, and pneumonia in 2.


Outcome in patients with bacterial meningitis presenting with a minimal Glasgow Coma Scale score.

Lucas MJ, Brouwer MC, van der Ende A, van de Beek D - Neurol Neuroimmunol Neuroinflamm (2014)

Distribution of scores on Glasgow Coma Scale for adults presenting with community-acquired bacterial meningitis
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4202677&req=5

Figure 1: Distribution of scores on Glasgow Coma Scale for adults presenting with community-acquired bacterial meningitis
Mentions: From 2006 to 2012, 1,083 episodes of community-acquired bacterial meningitis were included in the cohort. Thirty of 1,083 patients (3%) presented with a Glasgow Coma Scale score of 3 on admission (figure 1). Fifteen patients (50%) were female and the median age was 65 years (interquartile range 49–76 years; table 1). Fifteen patients (50%) had one or more predisposing conditions for bacterial meningitis, consisting of otitis/sinusitis in 8, immunocompromised state in 6, and pneumonia in 2.

Bottom Line: Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%).However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale.However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

View Article: PubMed Central - PubMed

Affiliation: Departments of Neurology (M.J.L., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and the Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.

ABSTRACT

Objective: In bacterial meningitis, a decreased level of consciousness is predictive for unfavorable outcome, but the clinical features and outcome in patients presenting with a minimal score on the Glasgow Coma Scale are unknown.

Methods: We assessed the incidence, clinical characteristics, and outcome of patients with bacterial meningitis presenting with a minimal score on the Glasgow Coma Scale from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2012.

Results: Thirty of 1,083 patients (3%) presented with a score of 3 on the Glasgow Coma Scale. In 22 of 30 patients (73%), the minimal Glasgow Coma Scale score could be explained by use of sedative medication or complications resulting from meningitis such as seizures, cerebral edema, and hydrocephalus. Systemic (86%) and neurologic (47%) complications occurred frequently, leading to a high proportion of patients with unfavorable outcome (77%). However, 12 of 30 patients (40%) survived and 7 patients (23%) had a good functional outcome, defined as a score of 5 on the Glasgow Outcome Scale. Patients presenting with a minimal Glasgow Coma Scale score on admission and bilaterally absent pupillary light responses, bilaterally absent corneal reflexes, or signs of septic shock on admission all died.

Conclusions: Patients with community-acquired bacterial meningitis rarely present with a minimal score on the Glasgow Coma Scale, but this condition is associated with high rates of morbidity and mortality. However, 1 out of 5 of these severely ill patients will make a full recovery, stressing the continued need for aggressive supportive care in these patients.

No MeSH data available.


Related in: MedlinePlus